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Clinical Orthopaedics and Related Research®

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01.01.2015 | Clinical Research

Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis

verfasst von: Bryce A. Basques, BS, Daniel D. Bohl, MPH, Nicholas S. Golinvaux, BA, Brian G. Smith, MD, Jonathan N. Grauer, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 1/2015

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Abstract

Background

Posterior spinal fusion (PSF) is commonly performed for patients with adolescent idiopathic scoliosis (AIS). Identifying factors associated with perioperative morbidity and PSF may lead to strategies for reducing the frequency of adverse events (AEs) in patients and total hospital costs.

Questions/purposes

What is the frequency of and what factors are associated with postoperative: (1) AEs, (2) extended length of stay (LOS), and (3) readmission in patients with AIS undergoing PSF?

Patients and Methods

Patients, aged 11 to 18 years, who underwent PSF for AIS during 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program^® (ACS NSQIP^®) Pediatric database. Patient were assessed for characteristics associated with AEs, extended LOS (defined as more than 6 days), and hospital readmission using multivariate logistic regression. Individual AEs captured in the database were grouped into two categories, “any adverse event” (AAE) and “severe adverse events” (SAEs) for analysis. A total of 733 patients met inclusion criteria.

Results

Twenty-seven patients (3.7%) had AAE and 19 patients (2.6%) had SAEs. Both AAE and SAEs were associated with BMI-for-age ninety-fifth percentile or greater (AAE: odds ratio [OR], 3.31; 95% CI, 1.43–7.65; p = 0.005. SAE: OR, 3.46; 95% CI, 1.32–9.09; p = 0.012). Extended LOS occurred for 60 patients (8.2%) and was associated with greater than 13 levels instrumented (OR, 2.00; 95% CI, 1.11–3.61; p = 0.021) and operative time of 365 minutes or more (OR, 2.57; 95% CI, 1.39–4.76; p = 0.003). Readmission occurred for 11 patients (1.5%), most often for surgical site infection, and was associated with the occurrence of any complication during the initial hospital stay (OR, 180.44; 95% CI, 35.47–917.97; p < 0.001).

Conclusions

Further research on prevention and management of obesity and surgical site infections may reduce perioperative morbidity for patients with AIS undergoing PSF.

Level of Evidence

Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

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Titel: Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis
verfasst von: Bryce A. Basques, BS
Daniel D. Bohl, MPH
Nicholas S. Golinvaux, BA
Brian G. Smith, MD
Jonathan N. Grauer, MD
Publikationsdatum: 01.01.2015
Verlag: Springer US
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 1/2015
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-3911-4

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Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis